Access to Allogeneic Cell Transplantation Based on Donor Search Prognosis: An Interventional Trial

Area of Science:

• Hematology
• Transplantation immunology
• Clinical informatics

Background:

• Allogeneic hematopoietic cell transplantation (HCT) relies on identifying suitable Human Leukocyte Antigen (HLA)-matched donors.
• The availability of an 8/8 HLA-matched unrelated donor (MUD) varies significantly among patients.
• A Search Prognosis calculator can predict the likelihood of finding an MUD.

Purpose of the Study:

• To evaluate if a search algorithm utilizing donor search prognosis can achieve similar HCT rates.
• To compare transplant incidence between patients with a very high (>90%) versus very low (<10%) probability of finding an MUD.

Main Methods:

• An interventional trial using a Search Prognosis-based algorithm for donor selection.
• Enrollment of 2225 patients with various hematologic malignancies and conditions from June 2019 to May 2022.
• Stratification into 'Very Likely' and 'Very Unlikely' arms based on MUD probability, with a 'Less Likely' arm for observation.

Main Results:

• 1751 patients were evaluable, with 413 (24%) from racial/ethnic minorities.
• The adjusted 6-month cumulative incidence of HCT was 59.8% in the 'Very Likely' group and 52.3% in the 'Very Unlikely' group (P=0.113).
• The algorithm facilitated rapid alternative donor identification, leading to comparable HCT rates.

Conclusions:

• A prospective Search Prognosis-based algorithm is feasible in a national multicenter trial.
• This approach enables efficient alternative donor identification.
• Comparable HCT rates were observed between patients with high and low probabilities of finding an MUD.